drugs used with syringe drivers and their respective indications

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Seek expert advice before prescribing medication for a syringe driver.

Medication Indication S.C. starting dose and range in 24 hours
Analgesic    
diamorphine

pain

when converting from oral morphine to s.c. diamorphine then diamorphine 24hr dose is 1/3 total 24hr dose of oral morphine

 

diamorphine dyspnoea

10-20mg (starting dose if not already taking opioids)

Increasing as necessary by 30-50% increments

Antiemetic    
metoclopramide impaired gastric emptying 30-40mg (range 30-80mg)
haloperidol drug induced or metabolic cause of nausea 2.5-5mg (range 2.5mg-10mg)
cyclizine intestinal obstruction 100-150mg (range 50-200mg)
Antiemetic and sedative    
levomepromazine nausea 2.5-12.5 mg
levomepromazine sedation, confusion, agitation 12.5-100mg
Sedative    
midazolam

terminal restlessness

myoclonic jerking

anticonvulsant

10-30mg (range 10-90mg)
clonazepam

terminal restlessness

myoclonic jerking

anticonvulsant

0.5-8mg
Anticholinergic    
Hyoscine hydrobromide (also antiemetic) terminal bronchial secretions 0.6-2.4mg
glycopyrronium terminal bronchial secretions 0.6-1.2mg
hyoscine butylbromide

severe colic

intestinal obstruction

60-120mg (range 60-180mg)
Steroid    
dexamethasone reduction in peritumour oedema see linked item
Anti-secretory    
octreotide intestinal obstruction to reduce secretions if hyoscine butylbromide ineffective 500 micrograms/24 hr initially (Range 50-600 micrograms/24 hours)

Contraindicated: DIAZEPAM, PROCHLORPERAZINE AND CHLORPROMAZINE are too irritant to be used subcutaneously.

Diamorphine or morphine should be the opioid of first choice for injection. To convert from oral morphine to subcutaneous diamorphine, divide the total 24 hr oral morphine dose by 3 to obtain the total 24hr diamorphine dose. When converting from oral morphine to subcutaneous morphine divide the 24 hr oral morphine dose by 2

e.g 3mg oral morphine = 1mg diamorphine subcutaneous injection 3mg oral morphine = 1.5mg morphine subcutaneous injection

The respective summary of product characteristics must be checked before prescribing any of the drugs mentioned.

Reference:

  1. West Midlands Palliative Care Physicians (2003). Palliative care - guidelines for the use of drugs in symptoms control.
  2. West Midlands Palliative Care Physicians (2007). Palliative care - guidelines for the use of drugs in symptoms control.

Last reviewed 01/2018

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